Confirmed Exchange QHPs: 12,101,891 as of 7/29/15
Estimated: 13.00M (9.88M via HCgov) as of 7/29/15

Estimated ACA-Enabled Policy Enrollment: 32.1M
(10.4M Paid/Effectuated Exchange QHPs, 7.0M OFF-Exchange QHPs, 200K SHOP, 14.5M Medicaid/CHIP)

Recently, Richard Simpkins (aka icowrich) took my latest state roundup of the known state-wide 2016 rate increase requests (updated with 14 states +DC) and took it one step further. He plugged the weighted average rate increases for each state into a spreadsheet and then ran a "weighted" average based on each state's proportion of the total U.S. population, like so:

...giving an overall rate increase of about 10.4%, which isn't fantastic but is right in line with the 10-12% which was typical nationally prior to the ACA.

Obviously this is a very partial picture, for several important reasons:

In addition to the normal off-season "Qualifying Life Events" which allow roughly 7,500 people to select a private policy nationally every day, it looks like up to 100K additional people might be added to either the QHP or Medicaid tally over the next month or so:

CMS will offer a special enrollment period to thousands of Healthcare.gov enrollees who were incorrectly told that they qualified for fewer subsidies than they should have received or none at all, due to a Social Security-related glitch in the eligibility system that inflated household income.

...Tricia Brooks, a senior fellow at Georgetown University's Center for Children and Families who frequently writes on the issue, estimates that the glitch affects around 40,000 households.

Not sure how this slipped by me earlier today...I've been so busy trying to figure out the 2016 rate increases for each state that I missed this report from HHS about the 2015 premium and competition changes at Healthcare.Gov (this doesn't include the state-based exchanges, but still covers 2/3 of the states and 3/4 of total private enrollments):

Competition and Choice in the Health Insurance Marketplace Lowered Premiums in 2015

The Health Insurance Marketplace established by the Affordable Care Act allows consumers to compare health insurance plans based on key factors, such as covered services, providers, and importantly, price. According to a report released today, choice and competition increased in the 2015 Marketplace and consumers benefitted as new issuers entered and price competition intensified. In 2015, 86 percent of Marketplace-eligible consumers could choose from at least three issuers, up from 70 percent in 2014.

The Rate Review database at Healthcare.Gov is a very useful tool for any insurance company requesting rate increases above 10%, but it's completely useless for requests below 10%. As such, I have hard data on the requested increases for about 600,000 Florida residents:

If Florida's entire ACA-compliant individual market was only 600K people, that would be the end of the story.

However, Florida actually has 16 different insurance companies selling individual policies...and the other 9 are all asking for lower than 10% hikes. After poking around the Florida Office of Insurance Regulation website as well as contacting the department directly, I've been able to pull together covered lives data for all 16, and requested rate change data for 3 more of them...2 of which are actually requesting rate decreases. When I add those 3 companies into the mix, the picture changes like so:

Back in June, I was both geeked and severely disappointed at the same time by Healthcare.Gov's brand-new Rate Review searchable database for listing the policy premium change requests by the hundreds of insurance companies operating both on and off of the ACA exchanges.

On the plus side:

The Office of the Inspector General released a big report today which confirms what most healthcare/ACA observers have known for awhile now: The CO-OP organizations established by the ACA across 2 dozen states to help increase competition and keep the private, for-profit insurance companies (somewhat) honest...haven't been doing very well overall.

One of these (CoOportunity, which operated in Iowa and Nebraska) seemed to be kicking ass in 2014...but ended up being liquidated by the end of the year. A second, operating in Louisiana, just announced that they're shutting down operations by the end of this year. As the OIG report notes, most of the 21 other CO-OPs nationally aren't doing so hot...and they used an absurdly long title (with an absurdly New York Post-style font size) to say so:

A judge has blasted a California software giant's claim that a cabal of campaign advisers are to blame for the decision to tank the state's $300 million Cover Oregon website project.

Oracle in February sued five campaign advisers and consultants to former Gov. John Kitzhaber, who resigned in February. Oracle argued the exchange was ready to roll out in February 2014, but said advisers led by Patricia McCaig pulled the plug on the project for political reasons.

On Monday, Multnomah Circuit Court Judge Henry Kantor issued a written opinion ripping Oracle's legal arguments using language that went far beyond his earlier e-mailed notice of the decision. He called Oracle's arguments "totally unsupported by the evidence provided."

Earlier today I posted about a mountain of data being released by the New York State of Health ACA exchange, including, among many other data points, the rough market share breakdown of the 19 insurance carriers operating on the exchange this year, like so:

  • Fidelis Care: 20%
  • Health Republic: 19%
  • Healthfirst: 10%
  • Empire BCBS: 10%
  • MetroPlus: 7%
  • MVP: 6%
  • Emblem: 6%
  • Oscar: 5%
  • Affinity: 5%
  • Excellus BCBS: 4%
  • UnitedHealthcare: 2%
  • North Shore: 2%
  • BCBS West. NY: 1%
  • CDPHP: 1%
  • Independent: 1%
  • Univera: <1%
  • Wellcare of NY: <1%
  • Empire BC (Upstate): <1%
  • BlueShield of NE NY: <1%

Assuming my ballpark estimate of appx. 7,500 Off-Season QHP Selections Per Day is accurate, the grand total nationally should be breaking the 13 million milestone right about...now-ish (or at least sometime this week).

I should note that thanks to this morning's New York update, the confirmed total has now officially broken the 12.1 million mark. The other 900,000 or so haven't been reported yet, and are mostly via Healthcare.Gov, of course.

Right on top of the Humana SEC filing I just wrote about comes this Q2 earnings conference call with Joe Swedish of Anthem (formerly WellPoint), which is an even larger insurance company nationally:

Our growth continues to be balanced so far in 2015 as we added 571,000 Medicaid members, 331,000 national members, 51,000 individual members and 16,000 local group members. As a reminder, we closed on the Simply Healthcare acquisition in February of this year, which contributed 209,000 members. These results have been supported by strong operating cash flow of $2.8 billion year-to-date, which represents 1.6 times net income.

Humana Group is one of the largest health insurance companies in the country. As such, their enrollment data being made available is extremely helpful in seeing where things stand and how they've changed nationally.

Today, Bob Herman of Modern Healthcare provided me with a link to Humana's latest SEC filing. In addition to a whole mess of financial info which is of little interest to me, there's also all sorts of year-over-year data about their enrollment numbers...including a very handy section about their individual market, broken out by ACA exchange-based, Off Exchange and even their non-ACA compliant enrollments (ie, "grandfathered" and/or "transitional" enrollees).

Here's the key section:

The New York State of Health (NY's ACA exchange) just released detailed numbers from the 2015 Open Enrollment Period.

Unfortunately, the data gets cut off as of 2/28/15, so this doesn't give any insight into the attrition rate since then (or a precise count of how many additional people enrolled during the #ACATaxTime special enrollment period which followed). However, it does give a lot of detailed analysis of the open enrollment period numbers, and does tack on an extra week's worth of private enrollments & 2 week's worth of CH+/Medicaid numbers (the official HHS report only ran through 2/21 for New York and the last press release with CH+/Medicaid numbers was as of 2/15).

As a result, the official numbers are slightly higher than what I had until now across the board:

(sigh) Just 2 days ago there was excellent news on the 2016 rate increase front from the largest state (California, 4% weighted average) and one of the smaller ones (Maine, just 0.7%). Today brings the other side of the coin: Assuming the requested rate hikes are approved, Minnesota is looking at some pretty unpleasant increases next year:

A team of actuaries at the Minnesota Department of Commerce are currently scrutinizing the proposed rates that have been filed for 2016, and final rates will be announced on October 1. But for now, four MNsure’s individual market carriers have proposed the following rate changes for coverage effective January 1, 2016 (market share is as of the end of the 2015 open enrollment period):

Remember that University of Michigan study I posted about last week which claimed that in spite of all the predictions by ACA opponents that expanding Medicaid would make it impossible for enrollees to actually make a doctor's appointment, the opposite ended up being the case?

A new University of Michigan study shows that the availability of primary care appointments actually improved for people with Medicaid in the first months after the state launched the Healthy Michigan Plan, the state’s Medicaid expansion under the ACA. What’s more, it remained mostly unchanged for those with private insurance.

Well, apparently the Michigan results are not an outlier:

I very rarely write much about Medicare here, partly because I just don't have time to cover every aspect of the healthcare system, partly because Medicare is only impacted by the ACA indirectly for the most part. However, there's been two recent developments which are worth noting:

First, that "indirect impact" I just mentioned has resulted in the Medicare Hospital Insurance Trust Fund, previously expected to run out of money just 2 years from now, now being expected to be solvent through 2030 thanks to the ACA bending the cost curve:

The slowing growth of healthcare costs has extended Medicare's projected lifespan 13 years beyond projections made in 2009, the last report issued before the passage of the Patient Protection and Affordable Care Act.

The Medicare Hospital Insurance Trust Fund will have "sufficient funds to cover its obligations until 2030," the Medicare Board of Trustees said Wednesday in its annual financial review of the $613 billion program.

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